I am a physician with long-standing interests in health policy, medical ethics and free-market economics. I am the co-founder of Freedom and Individual Rights in Medicine (FIRM). I graduated from University of Michigan Medical School and completed my residency in diagnostic radiology at the Washington University School of Medicine in St. Louis (where I was also a faculty member). I'm now in private practice in the Denver area. All my opinions are my own, and not necessarily shared by my employer.

How ObamaCare Creates Ethical Conflicts For Physicians And How Patients Can Protect Themselves

The federal government has also proposed linking physician payments to “appropriate use criteria.” Such government practice guidelines may be appropriate for many patients. However, there will always be patients who don’t fit the guidelines. In those cases, doctors will have to choose between what’s medically appropriate for their patient vs. adhering to the government-approved treatment guidelines.

Suppose you see your doctor for a severe headache. He examines you and says, “Nope, you don’t need an MRI scan. Take two Tylenol and call me in the morning.” Is he acting in your best interests? Or is he being inappropriately swayed by government practice guidelines intended to limit MRI usage?

To cut costs, many ObamaCare exchange plans also require “narrow networks” of providers, where patients may only receive treatment from a short list of approved hospitals and doctors. President Obama has repeatedly promised, “If you like your doctor, you can keep your doctor,” but many patients are learning the hard way that this isn’t true.

Such “narrow networks” also mean that many doctors will lose long-standing relationships with patients they’ve seen for years. Instead, doctors will be increasingly reliant on the government-run exchanges for new patients. This will create a powerful incentive for physicians to adhere to any treatment guidelines mandated by the government or by government-approved insurance plans.

Fortunately, patients can still partially protect themselves from conflicts of interest created by ObamaCare. Patients can ask their doctors if they have any incentives to limit their care (just as they can ask if their doctors have any incentives to favor particular treatments or tests).

Patients should also consider paying cash when appropriate. New federal regulations allow patients who pay cash to request that the details of their medical care not be sent to insurance companies. This frees your doctor to concentrate on doing what’s best for you without worrying that his treatment decisions might skew his practice statistics.

Some patients may also benefit from “direct pay” or “concierge” practices outside the standard insurance system. This allows the doctor to work for the patient, without interference from the government or government-controlled insurers.

Conclusion

Prior to ObamaCare, a few unethical doctors have always been tempted to overtreat patients. The big unknown is how physicians will respond to new incentives created by ObamaCare to undertreat patients. ObamaCare will divide doctors’ loyalty between the government (which will increasingly control their salaries) and you, the patient. How exactly that loyalty will be split will depend on each individual doctor. As economists say, “Incentives matter.” Under ObamaCare, you should take steps to make sure your doctor still puts your medical interests first.

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